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Calcifications - Suspicious - Amorphous / Malignancy (BI-RADS 4B)

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This is a 40 year old female presenting for a routine baseline screening

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mammogram. We can see, first of all, in this case that the technique

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image quality is not that great. On both of the MLO views, we

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rarely see any pectoralis muscle here on the right hand side

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and virtually none on the left hand side. This would not be great

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and probably recommend some additional views just for technical

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quality. In this case, the patient was not very tolerant of mammographic

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positioning, and so this was the best that the technologist could do.

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Looking sort of globally, we see some calcifications here in the right breast.

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This grouping here, and this one here and this here.

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On the left side, it looks normal. Pull down just the right hand side. On

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the right as we get a closer look, we'll look at this group

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of calcifications here. These have more stereotypical appearance of classic

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fat necrosis. Right? They're rim oriented calcifications. I see the associated

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circumscribed mass with it. And the right side, again, we see that small

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rim calcified mass. This is classically benign, nothing we can do about

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that. Further medial in the breast, in the CC view, we see this

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grouping of amorphous calcifications in quite a large group.

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Measuring, let's see what we got here, maybe about two and a half centimeters

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or so. On the MLO view, we see the corresponding group of calcifications

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here, putting this group of calcifications in the right breast at approximately

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one o'clock posterior depth. And this is a screening exam, so she got

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called back for further evaluation. But let's look at the tomosynthesis

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images just for completeness. As we scroll through this area, we can see

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these amorphous calcifications. And amorphous means that there's not a real

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distinct shape or size that we can tell.

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People describe it more classically as kind of grains of sand appearance

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in the mammogram. And we sort of get that sense in both of

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the views. You could argue for sure in this case that there are some

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associated asymmetry with these calcifications, and I would agree with that

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as well. So if we didn't see these

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very well, you could potentially try to find them by ultrasound if you

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wanted to. It's a little bit more challenging to do, but at least

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in theory possible with the associated asymmetry. But this patient ended

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up getting magnified mammographic views, our standard workup for calcifications.

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And again, in the medial right breast, we see these amorphous calcifications

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that are really difficult to see on this view. There's probably a little

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bit of motion here as well, but not easy.

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Similarly, on the ML view, we see those same calcifications here.

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It's clouded a little bit by the heterogeneously dense

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tissue, which is making it more difficult to see these calcifications. We

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can partially see that rim calcified mass we described earlier.

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Regardless, these amorphous calcifications are considered suspicious. They'd

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be given a BI RADS 4B and recommended for biopsy. This patient subsequently

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underwent image guidance, stereotactic biopsy, and this was biopsy proven

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malignancy.

Report

Description

Faculty

Ryan W. Woods, MD, MPH

Assistant Professor of Radiology

University of Wisconsin School of Medicine and Public Health

Tags

Women's Health

Tomosynthesis

Mammography

Breast

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